Early complications associated with oblique lateral interbody fusion in the treatment of degenerative lumbar diseases

Abstract

Objective To evaluate the early clinical outcomes and complications of oblique lateral interbody fusion (OLIF) in the treatment of degenerative lumbar diseases. Methods All of 83 patients, 29 males and 54 females with ages from 32 to 83 (average 60.8±13.7 y), underwent OLIF with or without posterior pedicle screw-rod instrumentations from October 2014 to February 2017. The index diagnosis was discogenic back pain in 17 cases, spondylolisthesis in 23, lumbar spinal canal stenosis in 25, and degenerative lumbar spinal kyphoscoliosis in 18 cases. The distribution of operative level was 5 at L1,2, 13 at L2,3, 38 at L3,4, and 69 at L4,5. The mean number of fusion level for each case was 1.5 segments. The operative duration, blood loss during operation, intra-operative and post-operative complications, the length of post-operative hospital stay were recorded. Clinical outcomes were evaluated using visual analogue scale (VAS) and Oswestry disability index (ODI). All patients were followed up for at least 3 months. Lumbar X-ray and CT scans were taken and the clinical outcomes were re-assessed during follow-up. Results Fifty-one in the 83 patients underwent supplementary posterior pedicle screw-rod instrumentation with OLIF procedures. The operation lasted for 43-295 min, with a mean duration of (153 ± 72) min. Mean operation time for each OLIF segment was 43±12 min. Blood loss during the operation was 30-800 ml, with a mean of 125±74 ml. Mean blood loss for each OLIF segment was 27±13 min. Average length of stay was 5.6 ± 3.2 d, ranging from 3-15 d. The VAS for back pain and leg pain and ODI scores were decreased apparently for each patient. The total incidence of complications was 22.9% (19/83), including 6.0% (5/83) of intra-operative complications (4 cases of cage subsidence, 1 case of segmental artery injury) and 16.9% (14/83) of post-operative ones. The latter consisted of ipsilateral hip flexor weakness in 6, ipsilateral anterolateral thigh pain in 2, ipsilateral lateral thigh numbness in 1, contralateral pain in flexion of hip in 1, ipsilateral sympathetic chain injury in 2, and pain in area of iliac bone donor site in 2. All symptoms were released or disappeared during follow-up. Conclusion OLIF as a novel minimally invasive technique can act as a safe and effective treatment for degenerative lumbar diseases, which can also reduce approach-related complications. Key words: Lumbar vertebrae; Intervertebral disc degeneration; Spondylolisthesis; Spinal stenosis; Scoliosis; Kyphosis; Spinal fusion; Intraoperative complications; Postoperative complications